Diabetic nephropathy （DN） is one of the most common and severe microvascular complications of diabetes， with a complex pathogenesis involving immune inflammatory responses， oxidative stress， apoptosis， glomerulosclerosis， renal interstitial fibrosis， and other pathological processes. In recent years， numerous animal or cell model experiments have revealed that the transforming growth factor-β （TGF-β）/mothers against decapentaplegic homolog （Smad）， phosphoinositide 3-kinase （PI3K）/ protein kinase B （Akt）/mammalian target of rapamycin （mTOR）， mitogen-activated protein kinase （MAPK）， AMP-activated protein kinase （AMPK）， nuclear factor-κB （NF-κB）， Janus kinase （JAK）/signal transducer and activator of transcription （STAT）， neurogenic locus notch homolog protein （Notch）， nuclear factor E₂-related factor 2 （Nrf2）， secretory glycoprotein （Wnt）/β-catenin， and other classical signaling pathways play important roles in the occurrence and development of DN. Traditional Chinese medicines， as natural drugs， possess characteristics such as multiple components， multiple targets， and few adverse reactions， demonstrating unique advantages in regulating the aforementioned signaling pathways and improving renal pathological changes. This review summarized recent research progress on the intervention of DN through the regulation of the aforementioned signaling pathways by single compounds and formulas of traditional Chinese medicine， focusing on their mechanisms of action in regulating immune inflammatory responses， inhibiting renal fibrosis， oxidative stress， improving metabolic disorders， and other aspects. The aim is to provide theoretical references for a deeper understanding of the modern pharmacological basis and clinical application of traditional Chinese medicine in the treatment of DN.

ObjectiveTo establish a high-performance liquid chromatography（HPLC） for the quantitative analysis of multiple components in Gegen Qinlian tablets， and to comprehensively evaluate the quality of samples from different manufacturers by integrating chemical pattern recognition and technique for order preference by similarity to ideal solution（TOPSIS）， in order to provide a reference basis for quality evaluation and control of Gegen Qinlian tablets. MethodsHPLC was employed to determine the contents of 10 components in 28 batches of Gegen Qinlian tablets collected from 6 manufacturers， and taking the detection results as variables， SIMCA 14.1 and SPSS 26.0 were employed for cluster analysis（CA）， principal component analysis（PCA）， and orthogonal partial least squares-discriminant analysis（OPLS-DA） to identify key components affecting the quality. Then， TOPSIS analysis was employed to rank the quality of Gegen Qinlian tablets from the 6 manufacturers and establish a comprehensive quality evaluation method. ResultsA quantitative method for Gegen Qinlian tablets was established. After methodological validation， the method was found to be stable and reliable， and could be used for the quantitative analysis of this preparation. The contents of 3′-hydroxy puerarin， puerarin， 3′-methoxy puerarin， daidzein， coptisine hydrochloride， epiberberine， jatrorrhizine hydrochloride， berberine hydrochloride， palmatine hydrochloride and baicalin in 28 batches of samples were 3.58-7.35， 24.88-42.32， 4.20-9.36， 4.33-7.60， 2.52-6.44， 0.93-4.10， 0.58-3.05， 10.68-22.92， 0.82-4.82， 11.73-60.16 mg·g^-1， respectively. Among them， puerarin， berberine hydrochloride and baicalin all met the limit requirements for this preparation specified in the 2025 edition of the Pharmacopoeia of the People's Republic of China. CA and PCA clustered the 28 batches of samples into 5 categories， PCA extracted 2 principal components with a cumulative variance contribution rate of 90.588%， and OPLS-DA screened out 4 differential markers with variable importance in the projection（VIP） values>1.0， namely baicalin， 3′-hydroxy puerarin， coptisine hydrochloride and palmatine hydrochloride， which might be the main components affecting the quality of Gegen Qinlian tablets. TOPSIS analysis showed that the comprehensive score of each evaluation index（C_i） values of different manufacturers were different. Among them， the C_i of manufacturer B was ranked higher， indicating potentially superior quality， while the C_i of manufacturer A was ranked lower， suggesting potentially inferior quality. ConclusionThis study establishes a quantitative method for Gegen Qinlian tablets， and the content uniformity of the same manufacturer is good， while there are differences in the contents of active components among different manufacturers. Through the chemical pattern recognition analysis， it is found that the content differences of Gegen Qinlian tablets may be related to baicalin， 3′-hydroxy puerarin， coptisine hydrochloride and palmatine hydrochloride.

Objective:The aim of this research was to study the transverse changes during molar distalization with clear aligner treatment,and to evaluate the predictability.Methods:This retrospective study included the following two parts:(1)20 patients treated with Invisalign system were selected.Their digital models were measured with OrthoCAD(Align Technology)and then com-pared with the initial ClinCheck arch width to verify the consistency between them;(2)34 patients whose maxillary molars were dis-talized,and 12 patients whose maxillary and mandibular molars were both distalized,were involved.The widths between canines,premolars and molars were recorded from Clincheck software at T0(initial),T1(Invisalign-predicted),and T2(pretreatment,from the refinement ClinCheck plan)and then compared.Results:The measured value of dental arch width of OrthoCAD and ClinCheck were consistent.After wearing the first stage appliance,the width between maxillary and mandibular teeth at T2 ranges from 1.63 to 3.45 mm.In the maxilla,the width at T1 differed from that at T2 and the predictability ranged from 80.43％to 82.29％,while the predictability ranged from 88.88％to 93.08％in the mandible.Conclusion:(1)The arches were expanded during molar distaliza-tion with clear aligners;(2)The predictability ranged from 80.43％to 93.08％.It can be considered that the actual width change is close to the target change.

This consensus will introduce the characteristics of fillers used in the surgical cavities of domestic nasal surgery patients based on relevant literature and expert opinions. It will also provide recommendations for the selection of cavity fillers for different nasal diseases, with chronic sinusitis as a representative example.
Humans ; Nasal Cavity/surgery* ; Nasal Surgical Procedures ; China ; Consensus ; Sinusitis/surgery* ; Dermal Fillers

Objective:The aim of this research was to study the transverse changes during molar distalization with clear aligner treatment,and to evaluate the predictability.Methods:This retrospective study included the following two parts:(1)20 patients treated with Invisalign system were selected.Their digital models were measured with OrthoCAD(Align Technology)and then com-pared with the initial ClinCheck arch width to verify the consistency between them;(2)34 patients whose maxillary molars were dis-talized,and 12 patients whose maxillary and mandibular molars were both distalized,were involved.The widths between canines,premolars and molars were recorded from Clincheck software at T0(initial),T1(Invisalign-predicted),and T2(pretreatment,from the refinement ClinCheck plan)and then compared.Results:The measured value of dental arch width of OrthoCAD and ClinCheck were consistent.After wearing the first stage appliance,the width between maxillary and mandibular teeth at T2 ranges from 1.63 to 3.45 mm.In the maxilla,the width at T1 differed from that at T2 and the predictability ranged from 80.43％to 82.29％,while the predictability ranged from 88.88％to 93.08％in the mandible.Conclusion:(1)The arches were expanded during molar distaliza-tion with clear aligners;(2)The predictability ranged from 80.43％to 93.08％.It can be considered that the actual width change is close to the target change.

Objective To observe the efficacy of modified endoscopic sinus surgery(ESS)in treatment of chronic rhinosinusitis with nasal polyps(CRSwNP)complicated by allergic rhinitis(AR).Methods Forty patients with CRSwNP and perennial AR who were scheduled for ESS were divided into study group and control group,with 20 cases in each group.The control group was treated with conventional ESS,while the study group underwent resection of a large part of the middle turbi-nate on the basis of ESS to enhance middle meatal drainage.The postoperative mucosal outcomes,complications,as well as the Visual Analog Scale(VAS),sino-nasal outcome test-20(SNOT-20),and nasal endoscopic Lund-Kennedy scores before surgery,at 3 months after surgery,and at 1 year af-ter surgery were compared between the two groups.Results In the control group,there were 3 cases of local adhesion between the displaced middle turbinate and the lateral nasal wall at 3 months after surgery,and 10 cases of middle turbinate edema at 1 year after surgery,including 4 cases with local polypoid changes in the middle turbinate and polypoid hyperplasia in the ethmoid sinus and frontal re-cess regions.No complications were observed in the study group,and the epithelialization of the surgical area was good.Moreover,the nasal congestion score,olfactory score,and Lund-Kennedy score at 1 year after surgery in the study group were lower than those in the control group,with statistically significant differences(P＜0.05).Conclusion Modified ESS can significantly improve nasal con-gestion and olfactory symptoms in patients with CRSwNP complicated by perennial AR and effective-ly enhance their quality of life.

Objective:To analyze the correlations between the ultrasound contrast features and the expression of human epidermal growth factor receptor 2(HER-2)of molecular biological indicators of breast cancer,and between ultrasound elastography features and that.Methods:A total of 63 patients with invasive breast cancer who admitted to The Affiliated Suzhou Hospital of Nanjing Medical University and The First Affiliated Hospital of Jiamusi University from February 2019 to June 2022 were selected as the study subjects.The HER-2 positive expression of molecular biological indicator of breast cancer was measured by immunohistochemistry.According to the immunohistochemical results,the patients were divided into positive group(22 cases)and negative group(41 cases).All patients underwent examinations of ultrasound contrast and ultrasound elastography.The differences of the features of ultrasound contrast and ultrasound elastography between the two groups were analyzed and compared.The influencing factors of HER-2 positive expression were analyzed by binary logistic regression,and the receiver operating curve(ROC)was established to assess respectively the values of single ultrasound contrast,single ultrasound elastography and the combination of them in predicting HER-2 positive expression.Results:There was significant differences in the features of ultrasound elastography between the two groups.The ratios of the irregular shape and burr at the edge of the imaging features of the patients with HER-2 positive expression were significantly higher than those of the patients with HER-2 negative expression[(86.4%vs.58.5%)and(77.3%vs.51.2%)],and the differences were statistically significant(x2=5.117,4.060,P<0.05),respectively.The difference of the features of ultrasound contrast between two groups was significant.The ratios of nourishing vessels,and the lesion enlargement≥3 cm after angiography in patients with HER-2 positive expression were significantly higher than those in the patients with HER-2 negative expression[(77.3%vs.41.5%)and(81.8%vs.39.0%)],the differences were statistically significant(x2=7.390,10.554,P<0.05),respectively.The features(shape,edge,nourishing vessels and lesion enlargement after contrast)of ultrasound contrast and ultrasound elastography were used respectively as independent variables,and the HER-2 positive expression was used as dependent variables.The logistic regression analysis showed that regular shape,smooth edge,without nourishing vessels and enlarged lesion<3 cm after angiography were protective factors for HER-2 positive expression of patients with breast cancer(OR=0.185,0.199,0.070,0.186,P<0.05),respectively.The areas under curve(AUC)values of the ROC curve of imaging features(shape,edge,nourishing vessels,and lesion enlargement after angiography)of ultrasound contrast and ultrasound elastography were respectively 0.630,0.639,0.679 and 0.714 in single predicting HER-2 positive expression of patients with breast cancer,and that of the combination of them was 0.874 in prediction.Conclusion:In features of ultrasound contrast and ultrasound elastography,the shape,edge,nourishing vessels and the enlargement lesion after contrast were the influencing factors of HER-2 positive expression in patients with breast cancer.The combined assessment of ultrasound contrast and ultrasound elastography before surgery has certain clinical reference value in predicting HER-2 expression.

Objective:To explore the differences of the circadian rhythm gene polymorphisms between patients with major depressive disorder and those with bipolar disorder, providing a genetic basis for differential diagnosis.Methods:70 patients who were still diagnosed with major depressive disorder after 5 years and 68 patients who were still diagnosed with bipolar disorder from Zhongda Hospital affiliated to Southeast University from 2012 to 2018 were included in this study. Single nucleotide polymorphisms (SNPs) of circadian rhythm gene were selected for genetic testing. And the differences in genotype frequency, allele frequency, and haplotypes of each SNP between major depressive disorder and bipolar disorder were analyzed using UNPHASED 3.1.7.Results:The analysis of genotype frequency revealed statistically significant differences in genotype frequency of PER1rs2253820, PER1rs2735611, PER3rs12566042, PER3rs17031614, and PER3rs79372391 between the two groups ( OR(95% CI)=2.386(1.173-4.854), 2.357(1.166-4.764), 0.351(0.176-0.703), 0.389(0.196-0.773), 0.389(0.196-0.773) respectively; all P<0.05). Haplotype analysis showed that the T-C-C-T-G haplotype, in CLOCK loci (rs12505266, rs2272073, rs3817444, rs11133389 and rs12505265) was significantly different between major depressive disorder group and bipolar disorder group ( OR(95% CI)=0.108(0.010-1.185), P=0.027). Conclusion:There are significant differences in circadian rhythm gene polymorphisms between patients with major depressive disorder and bipolar disorder. Carrying the PER1rs2253820TT and PER1rs2735611GG genotypes is a risk factors for bipolar disorder.

Objective:To establish a model for predicting the risk of hyperuricemia in helicopter pilots stationed in plateau and to verify the application effect of the model.Methods:By using a convenience sampling method, 409 pilots who recuperated in Air Force Healthcare Center for Special Services Hangzhou from August of 2017 to March of 2023 were selected as the subjects, and a retrospective analysis was conducted on the relevant data. They were randomly divided into modeling group (286 cases) and validation group (123 cases) with the ratio of 7∶3. Lasso regression and Logistic regression analysis were used in screening out the influencing factors of hyperuricemia for the helicopter pilots stationed in plateau. R software was used to construct risk prediction model and column chart model. The prediction effect of the model was tested using the area under the operating characteristic curve of the subjects.Results:TG, ALT, exercise intensity were the influencing factors of hyperuricemia in altitude helicopter pilots ( Z=2.62, 2.68, -3.02, P=0.009, 0.007, 0.003). Based on the above 3 influencing factors, a risk prediction model and a column chart model were constructed, and the receiver operating characteristic curve was drawn. The results showed that the area under the curve (AUC) of the modeling group was 0.758,95% CI was 0.696-0.820. The Yoden index was 0.331, the sensitivity was 76.5%, and the specificity was 56.6%. The AUC of the validation group was 0.747, 95% CI was 0.655-0.840. The Yoden index was 0.642, the sensitivity was 68.6%, and the specificity was 85.2%,respectively, those suggested good predictive result. The calibration curve showed that the model performed well in predicting compliance, and the clinical decision curve analysis showed that the model performed well in clinical efficacy. Conclusions:The prediction model constructed in this study has good discrimination and calibration, and can help medical staff to screen out high-risk populations of the helicopter pilots with hyperuricemia, and take targeted intervention measures.

Objective:To explore the differences of the circadian rhythm gene polymorphisms between patients with major depressive disorder and those with bipolar disorder, providing a genetic basis for differential diagnosis.Methods:70 patients who were still diagnosed with major depressive disorder after 5 years and 68 patients who were still diagnosed with bipolar disorder from Zhongda Hospital affiliated to Southeast University from 2012 to 2018 were included in this study. Single nucleotide polymorphisms (SNPs) of circadian rhythm gene were selected for genetic testing. And the differences in genotype frequency, allele frequency, and haplotypes of each SNP between major depressive disorder and bipolar disorder were analyzed using UNPHASED 3.1.7.Results:The analysis of genotype frequency revealed statistically significant differences in genotype frequency of PER1rs2253820, PER1rs2735611, PER3rs12566042, PER3rs17031614, and PER3rs79372391 between the two groups ( OR(95% CI)=2.386(1.173-4.854), 2.357(1.166-4.764), 0.351(0.176-0.703), 0.389(0.196-0.773), 0.389(0.196-0.773) respectively; all P<0.05). Haplotype analysis showed that the T-C-C-T-G haplotype, in CLOCK loci (rs12505266, rs2272073, rs3817444, rs11133389 and rs12505265) was significantly different between major depressive disorder group and bipolar disorder group ( OR(95% CI)=0.108(0.010-1.185), P=0.027). Conclusion:There are significant differences in circadian rhythm gene polymorphisms between patients with major depressive disorder and bipolar disorder. Carrying the PER1rs2253820TT and PER1rs2735611GG genotypes is a risk factors for bipolar disorder.